Provider Demographics
NPI:1194909515
Name:NEUROLOGICAL SURGERY LTD PC
Entity type:Organization
Organization Name:NEUROLOGICAL SURGERY LTD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-455-1803
Mailing Address - Street 1:2460 W 26TH AVE STE 220C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-5347
Mailing Address - Country:US
Mailing Address - Phone:303-455-1803
Mailing Address - Fax:
Practice Address - Street 1:2460 W 26TH AVE STE 220C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-5347
Practice Address - Country:US
Practice Address - Phone:303-455-1803
Practice Address - Fax:303-455-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04984084Medicaid